Unintentional falls are a leading cause of nonfatal injury in children younger than 19 years of age in the United States (table 1) [1] and 8 percent of fatal children's injuries worldwide [2]. Fall-related mortality in children has declined since 1987; nonetheless, according to the National Center for Injury and Prevention and Control in 2015, 123 unintentional fall-related deaths occurred in children younger than 20 years: 34 in children younger than five years, 12 in children between 5 and 9 years, 13 in children between 10 and 14 years, and 64 in children between 15 and 19 years [3]. Boys were more than three times as likely as girls to die from fall-related injuries [4].

Emergency department and outpatient surveillance systems indicate that falls are one of the most common injuries requiring medical care and the most common nonfatal injury requiring hospitalization [5-7]. Each year, 2.8 million children are treated in emergency department for fall-related injuries, with children younger than five years of age representing the largest proportion of visits [1,8-10].

In the pediatric age group, children younger than five years of age are at the greatest risk of incurring fall-related injury; they are injured at rates higher than any other age group except individuals older than 75 years, who have the highest fall-related injury rates [1]. Falls are also the most frequent cause of any injury during infancy (an estimated 35.1 per 1000 infant-years) [11]. The combination of curiosity, immature motor skills, and lack of judgment renders preschool children particularly susceptible to falling (eg, as they climb on furniture to obtain toys that are out of reach).

Falls by children occur mainly in the warmer months [12-14]. The location and mechanism of injuries caused by falls vary depending upon the age of the child. More than 80 percent of fall-related injuries in children younger than four years of age occur in the home; among children aged 5 to 14 years, approximately one-half of the injuries occur at home and one-quarter at school. Infants are at risk for falling from furniture or stairs [13,15,16], toddlers are at risk for falling from windows, and older children are at risk for falling from playground equipment.

Children from low-income families are more likely to be injured from falls due to lack of safety equipment (eg, window guards) or deteriorating housing [17-19]. Additional predisposing factors for fall injuries identified in case series include history of previous unintentional injury, neurologic disorder (eg, seizures, developmental delay, hyperactivity), documented parental neglect, and acute stressors (eg, recent move, illness, or job change) [20-23].

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Baby Walkers: A Dangerous Choice. Available at: https://www.healthychildren.org/English/safety-prevention/at-home/Pages/Baby-Walkers-A-Dangerous-Choice.aspx (Accessed on April 21, 2017).

United States Consumer Product Safety Commission; Injuries and Deaths Associated with Nursery Products Among Children Younger than Age Five for 2014. Available at: www.cpsc.gov//Global/Research-and-Statistics/Injury-Statistics/Toys/Nursery-Products-Annual-Report-2014.pdf (Accessed on April 22, 2017).

Centers for Disease Control and Prevention. Playground Injuries Fact Sheet. Available at: www.cdc.gov/HomeandRecreationalSafety/Playground-Injuries/playgroundinjuries-factsheet.htm (Accessed on April 22, 2017).

United States Consumer Product Safety Commission. Public Playground Safety Handbook. U.S. Government Printing Office, Washington, DC, 2010. Available at: https://www.cpsc.gov/Pagefiles/122149/325.pdf (Accessed on April 22, 2017).